Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria

Motter, Fabiane Raquel; Fritzen, Janaína Soder; Hilmer, Sarah N.; Paniz, Érika Vieira; Paniz, Vera Maria Vieira

doi:10.1007/s00228-018-2446-0

Cited by 209 publications

(239 citation statements)

References 72 publications

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“…A recent systematic review of validated explicit criteria has also shown the necessity for information on alternative therapies and special use considerations to help clinicians make decisions about drug prescriptions. 26 Several limitations of the present study should be acknowledged. First, it was an observational study carried out in a single medical unit at a Japanese university hospital.…”

Section: Discussionmentioning

confidence: 85%

“…STOPP‐J presented the “recommended usage” and the flowcharts for changing medications together with lists of PIM, which were helpful for the pharmacists and physicians. A recent systematic review of validated explicit criteria has also shown the necessity for information on alternative therapies and special use considerations to help clinicians make decisions about drug prescriptions …”

Section: Discussionmentioning

confidence: 99%

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Efficacy of pharmacists' assessment and intervention based on Screening Tool for Older Persons' Appropriate Prescriptions for Japanese compared with Screening Tool for Older Persons' Appropriate Prescriptions for Japanese criteria version 2 in older patients with cardiovascular disease

Kondo

Ogura

Kukita

et al. 2019

Geriatrics Gerontology Int

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Aim This study aimed to evaluate the efficacy of pharmacists' assessment and intervention using the Screening Tool for Older Persons' Appropriate Prescriptions for Japanese (STOPP‐J) to detect and correct potentially inappropriate medications (PIM) compared with the Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (STOPP) criteria version 2. Methods A prospective observational study was carried out at a medical unit of Cardiovascular Surgery and Cardiovascular Internal Medicine in a Japanese university hospital involving new inpatients aged ≥65 years prescribed one or more daily medication. Pharmacists detected PIM based on STOPP‐J and STOPP criteria version 2, and corrected them with physicians. The number of patients with PIM, the content and changes in PIM were compared between both criteria. Results Overall, 230 patients were included (mean age 75.4 years, 162 men, mean number of medications 8.3). STOPP‐J detected significantly more patients with PIM than STOPP criteria version 2 (122 [53%] vs 75 [33%], P < 0.001). The number of PIM based on STOPP‐J was 232, the physicians were recommended to change 61 (26%) and 50 (22%) were changed. Meanwhile, the number of PIM based on STOPP criteria version 2 was 133, the physicians were recommended to change 61 (46%) and 54 (41%) were changed. Several medications detected as PIM using STOPP‐J were not detected using STOPP criteria version 2. Conclusions STOPP‐J detected significantly more patients with PIM than STOPP criteria version 2, and pharmacists' assessment and intervention based on STOPP‐J were suggested to be effective for detecting and correcting PIM. Geriatr Gerontol Int 2019; 19: 1101–1107.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Efficacy of pharmacists' assessment and intervention based on Screening Tool for Older Persons' Appropriate Prescriptions for Japanese compared with Screening Tool for Older Persons' Appropriate Prescriptions for Japanese criteria version 2 in older patients with cardiovascular disease

Kondo

Ogura

Kukita

et al. 2019

Geriatrics Gerontology Int

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“…The greater the number of prescriptions, the more likely there will be potentially inappropriate medications (PIMs) [3,4]. PIMs are medications for which the risk of adverse events outweighs clinical benefits, especially when safer alternatives are available [5,6]. Few studies have evaluated the prevalence of PIMs in the preoperative setting and its association with postoperative outcomes [7][8][9].…”

Section: Background and Objectivesmentioning

confidence: 99%

Potentially Inappropriate Medication Use in Older Adults in the Preoperative Period: A Retrospective Study of a Noncardiac Surgery Cohort

Forget

McDonald

Shema

et al. 2020

Drugs - Real World Outcomes

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Background Few studies have evaluated the prevalence of potentially inappropriate medications (PIMs) and its association with postoperative outcomes in a geriatric population in the preoperative setting. Objectives The purpose of this study was to evaluate the prevalence of PIMs in an older elective surgery population and to explore associations between PIMs and postoperative length of stay (LOS) and emergency department (ED) visits in the 90 days post hospital discharge, depending on frailty status. Methodology We performed a retrospective cohort study of older adults awaiting major elective noncardiac surgery and undergoing an evaluation in the preoperative clinic at a tertiary academic center between 2017 and 2018. We identified PIMs using MedSafer, a software tool built to improve the safety of prescribing. Frailty status was assessed using the 7-point Clinical Frailty Scale. We estimated the association between PIMs and postoperative LOS and ED visits in the 90 days post hospital discharge. Results The MedSafer software generated 394 recommendations on PIMs in 1619 medications for 252 patients. In total, 197 (78%) patients had at least one PIM. The cohort included 138 (51%) robust, 87 (32.2%) vulnerable and 45 (16.7%) frail patients. The association between PIMs and LOS was not significant for the robust and frail subgroups. For the vulnerable patients, every additional PIM increased LOS by 20% (incidence rate ratio 1.20; 95% confidence interval 0.90-1.44; p = 0.089) without reaching statistical significance. No association was found between PIMs and ED visits. Conclusion PIMs identified by the MedSafer software were prevalent. Preoperative evaluation represents an opportunity to plan deprescribing of PIMs.

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“…There are several tools to evaluate potentially inadequate prescribing 16–18. Among all of them, the explicit criteria STOPP-START (screening tool of older person's potentially inappropriate prescriptions/screening tool to alert doctors to right treatment) are the most used and validated in European older people.…”

Section: Introductionmentioning

confidence: 99%

“…In recent years, many studies have been published using the STOPP-START criteria to assess the adequacy of medications in the community, socio-health centres and/or nursing homes, and the hospital setting 14 18 22–28. At the time of initiating this study, no published analyses were available with the objective to describe the relationships between multimorbidity, PIP and ADRs.…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity patterns in chronic older patients, potentially inappropriate prescribing and adverse drug reactions: protocol of the multicentre prospective cohort study MoPIM

et al. 2020

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IntroductionMultimorbidity is a major challenge for current healthcare systems and professionals. From the different approaches that have been proposed to analyse this issue, the hypothesis of the existence of association patterns of different chronic conditions is gaining visibility. In addition, multimorbidity can be associated to polypharmacy, which can lead to a higher risk of potentially inappropriate prescribing (PIP) and consequently to adverse drug reactions (ADRs). The general objective of this novel study is to identify the association between PIP, multimorbidity patterns, polypharmacy and the presence of ADRs in older patients admitted for exacerbation of chronic diseases.Methods and analysisThe MoPIM (morbidity, potentially inappropriate medication) study is a multicentre prospective cohort study of an estimated sample of 800 older (≥65 years) patients admitted to five general hospitals in Spain due to an exacerbation of a chronic disease. Patients referred to home hospitalisation, admitted due to an acute process or with a fatal outcome expected at the time of admission are excluded. Sociodemographic data, chronic morbidities and geriatric syndromes, number of chronic prescribed medications, PIP at admission to hospital and on discharge, according to the newest screening tool of older screening tool of older person's potentially inappropriate prescriptions/screening tool to alert doctors to right treatment criteria, and ADRs during hospitalisation are being collected. Multimorbidity patterns will be identified using cluster analyses techniques, and the frequency of polypharmacy, PIP and ADRs will be calculated. Finally, the possible relationship between those indicators will be identified through bivariate and multivariate analyses.Ethics and disseminationThe project has been approved by the clinical research ethics committees of each centre: Comité Ético de investigación Clínica del Parc Taulí, Comitè Ètic d'Investigació Clínica Osona per a la Recerca i Educació Sanitàries (FORES), Comité de Ètica de la Investigación con Medicamentos (CEIm)-Parc de Salut MAR, Comité Ético de Investigación Clínica de Euskadi, Comité de Ética de Investigación del Hospital Universitario de Canarias. The results will be actively and mainly disseminated through publication in peer-reviewed journals and communications in scientific conferences.Trial registration numberNCT02830425.

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Potentially inappropriate medication in the elderly: a systematic review of validated explicit criteria

Cited by 209 publications

References 72 publications

Efficacy of pharmacists' assessment and intervention based on Screening Tool for Older Persons' Appropriate Prescriptions for Japanese compared with Screening Tool for Older Persons' Appropriate Prescriptions for Japanese criteria version 2 in older patients with cardiovascular disease

Efficacy of pharmacists' assessment and intervention based on Screening Tool for Older Persons' Appropriate Prescriptions for Japanese compared with Screening Tool for Older Persons' Appropriate Prescriptions for Japanese criteria version 2 in older patients with cardiovascular disease

Potentially Inappropriate Medication Use in Older Adults in the Preoperative Period: A Retrospective Study of a Noncardiac Surgery Cohort

Multimorbidity patterns in chronic older patients, potentially inappropriate prescribing and adverse drug reactions: protocol of the multicentre prospective cohort study MoPIM

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